Russia has invaded Ukraine and many people - including doctors and other healthcare workers
- are worried about the possibility of a draft should things escalate to a global scale.
If you’re a nurse, resident, doctor, or another healthcare worker, should you be worried?
How likely is a medical draft?
And if one were to occur, what would it look like?
Let’s talk about it.
Dr. Jubbal, MedSchoolInsiders.com.
As the conflict between Russia and Ukraine continues to unfold, many are fearful that
the situation will escalate into a multinational conflict.
Ukraine borders several NATO allies including Poland, Slovakia, Hungary, and Romania.
If Russia were to engage even one of these countries, then the US, France, Germany, UK,
and the rest of the NATO allies would be forced to respond.
The implications of such a global war could be catastrophic given the prevalence of nuclear
weapons.
The United States and Russia possess a combined total of over 13,000 nuclear warheads - which
is 90% of the estimated global inventory.
Just one of these weapons has the potential to destroy a large city and kill millions
of people.
The use of tens or hundreds of nuclear weapons has the potential to disrupt the global climate
— the consequences of which would be immeasurable.
As such, many are fearful that the situation in Ukraine has the potential to start a much
larger conflict and involve many more countries.
Today we’re going to discuss the history of the draft, what a medical draft would look
like, and how likely it is to happen.
We’ll focus primarily on the US but stick around to the end because we’ll also cover
the United Kingdom, Canada, and India.
Conscription, more commonly known as “the draft,” is the mandatory enrollment of individuals
into the armed service.
There have been several instances throughout American history where drafts have been used
including the Civil War, World War I, World War II, and more recently, the Vietnam War.
The last draft in the US occurred in 1973 and the military has been voluntary enlistment
ever since.
That being said, the US government has continued to collect information on civilians who are
eligible to serve should the need arise.
Today, every male between the ages of 18 and 25 is required to register for the Selective
Service System.
This creates a large database of individuals who can be called upon to serve in the event
of a national emergency.
If you are a male living in the United States, you were probably already aware of this as
you likely registered for Selective Services at the age of 18.
What many people aren’t aware of, however, is that the US has standby plans developed
by the Selective Service System to draft doctors, nurses, and other medical technicians into
the military in the event of a national crisis.
It is called the Health Care Personnel Delivery System, or HCPDS for short.
In previous wars, including WWII and the Vietnam war, doctors have been considered strategic
assets and had to participate in separate drafts - often with higher rates of selection.
The HCPDS was designed in 1986 as a way to more quickly mobilize specialized healthcare
personnel in the event that the military’s existing medical capabilities are insufficient
and there is a shortage of volunteers.
It was designed to be implemented in connection with a national mobilization and requires
approval from both Congress and the President to enact.
If implemented, this would allow healthcare professionals between the ages of 20 and 45
to be drafted into the military - including women, unless otherwise directed by Congress
or the President.
In fact, some argue that it is very likely that women would be included in a medical
draft given it would be difficult to get enough professionals within certain specialties without
them.
So even if you are outside of the age or gender requirements for a general draft through Selective
Services, you still may be eligible for recruitment in a medical draft should the need ever arise.
If the HCPDS were enacted, the Selective Service System notes that they would be able to begin
mass registration of healthcare workers across over 60 medical and related specialties in
as little as 2 weeks.
Since draftees would already be trained professionals, the training process would also be fairly
quick.
If you’re a healthcare worker, aged 20 through 45, and Congress authorizes a medical draft,
you could be enlisted in a matter of a few months.
So we know these standby plans exist, but how likely is the US government to actually
enact a medical draft?
To start, there would have to be a sufficient national emergency to warrant a medical draft.
At the time of recording this video, the White House has made it clear that it is not interested
in directly engaging with the Russian military.
Additionally, the approach by NATO at this time has been to influence the success of
Ukraine by providing support instead of getting directly involved.
But even in the event that the US were to become involved in the conflict, there is
no guarantee that their involvement would warrant the use of a draft - medical or otherwise.
We can talk hypotheticals all we want, but nobody can predict for certain how this situation
will pan out.
As it stands, however, most Americans are strongly opposed to a military draft - nearly
80% according to a 2016 poll by Cornell University.
To no surprise, most physicians and healthcare workers are also strongly opposed to a medical
draft.
When drafted, the needs of the military dictate when and where you are deployed.
You are sent where the military determines you are needed.
In addition, most physicians have been trained and equipped to deal with civilian medical
issues, not battlefield casualties.
As such, many see engaging in war and militarism as contradictory to the Hippocratic oath they
took when they became a doctor.
Although the idea of a medical draft is wildly unpopular, the fact is that the military needs
doctors during times of crisis and we are already experiencing significant shortages
in military physicians.
A report from the Government Accountability Office warned that the Department of Defense
is experiencing gaps between funded positions for military physicians and the number of
physicians filling those positions by the end of the year - including “persistent
gaps in specialties identified as critically short wartime specialties.”
They attributed these shortages to difficulty attracting and retaining military physicians
due to national shortages and competition with the private sector.
They conclude that “until the DoD is able to alleviate gaps in critical specialties,
it may be hindered in its ability to provide medical support for its service members during
wartime.”
Another 2018 report from the Inspector General concluded that the military health system
lacks the manpower to even handle the routine health needs of service members during normal
conditions.
At one sampled Air Force facility, there was only one provider for every 1,600 patients.
This far exceeds the recommended regulation of 1,250 patients per provider which is already
considered a heavy caseload.
We’ve already seen glimpses of these shortages during the coronavirus pandemic.
To address the needs of COVID patients, the Army had to reach out to retired military
doctors and medics to return to service as a part of a voluntary recall.
Fortunately, over 25,000 volunteers stepped forward to assist; however, in the event of
a major crisis, this would likely be far from enough.
Given existing shortages, many argue that a medical draft would be more likely to occur
than a general draft in the event of a crisis as the military would need individuals with
specialized skills far sooner than they would need a general draft of young men.
Up until this point, we’ve focused mainly on the United States; however, conscription
- healthcare workers or otherwise - is not unique to the US.
According to the Pew Research Center, the US is one of 23 countries where the military
draft is authorized but not currently implemented.
There are another 60 countries with some form of active draft program and the remaining
108 countries have no laws authorizing conscription.
Let’s cover the likelihood of a draft in a few other countries.
The United Kingdom has implemented military drafts only twice during modern times - once
during World War I and again during World War II.
At that time, police officers, medical personnel, prison workers, students, government employees,
and ministers were exempt from the draft.
After World War II, the United Kingdom implemented the National Service Act, which required all
physically fit males between the ages of 17 and 21 to serve in one of the armed forces
for an 18-month period and remain on the reserve list for an additional four years.
The service requirement was later increased from 18 months to 2 years; however, National
Service ended in 1960 with the last national servicemen being discharged in 1963.
Since then, there has been no conscription legislation in the UK and, unlike the US with
the Selective Service System, there are no remnants of the draft.
That being said, Parliament could theoretically pass a law reestablishing it during a time
of national crisis; however, many believe this is unlikely.
Similar to the UK, the Canadian government has only enacted military drafts twice in
its history - again, during WWI and WWII.
Both instances created sharp divisions between English Canadians, who generally supported
the practice, and French Canadians, who generally did not.
The Canadian armed forces have been voluntary since then and there has been no conscription
legislation since WWII.
Given the deep divisions that conscription created and the unease that remains surrounding
the practice, it is thought to be unlikely that Canada would reintroduce the draft.
Unlike the UK and Canada, India has never utilized a military draft.
Throughout its history, the Indian army has always been voluntary - even during World
Wars I and II.
Despite this, India has the second-largest army in the world in terms of active-duty
military personnel - positioning itself just between the United States in third and China
in first.
As such, it is thought to be unlikely that India would ever implement a military draft.
This is a crazy time in the world right now.
Our thoughts are with those in Ukraine.
Although there is a lot of uncertainty and many are fearful about how this can unfold,
it is best not to dwell on situations that may or may not occur.
Although it is interesting to explore hypotheticals from time to time, it is important to remember
that these are not certainties.
You can spend your time and energy worrying about something that may happen only for that
situation to never come true.
As the stoic philosopher Seneca put it, “we suffer more often in imagination than in reality.”
Thank you all so much for watching.
Slava Ukraini.
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Much love, and I’ll see you in that next one.